My Name is Paul H Cosentino. I started this Blog in 2011 because of what I believe to be wrongdoings in town government. This Blog is to keep the citizens of Templeton informed. It is also for the citizens of Templeton to post their comments and concerns.

Paul working for you.

Sunday, February 19, 2017

Quarantine Powers

CDC Publishes Final Rule on Quarantine Powers

The federal government’s legal authority to detain and quarantine
persons infected with certain highly communicable and deadly infectious
diseases historically primarily has involved detaining people entering
the U.S. by boats and airplanes or traveling across state lines.

Federal government officials have long had the authority to
apprehend, isolate and quarantine people for a limited number of
infectious diseases on the U.S. quarantine list.

However, the legal authority for surveillance, detention and
quarantining of citizens residing in the U.S. suspected of being
infected with certain non-quarantinable communicable diseases
historically has resided with state government health officials.1

On Jan. 17, 2017, the last day of the Obama administration, a new
final rule on the Control of Communicable Diseases was issued by the
U.S. Centers for Disease Control and Prevention (CDC) that is schedule
to take effect in March.

The new rule gives the CDC expanded authority to apprehend, isolate
and quarantine for at least 72 hours a person entering the U.S. or
traveling between states, who is suspected of being infected, or at risk
of being infected, with one of the nine diseases on the U.S. quarantine
list (cholera, plague, diphtheria, smallpox, yellow fever, infectious
tuberculosis, viral hemorrhagic fevers [like Ebola], severe acute
respiratory syndrome [SARS] and influenza) that can cause a pandemic.2

The rule also strengthens federal surveillance of travelers for
symptoms of non-quarantinable diseases like measles, pertussis and
meningococcal disease.3

While proponents are touting the changes as necessary to protect the
public health, critics have been arguing since the CDC first published
the Notice of Proposed Rule Making (NPRM) in August 2016, that it is an
example of government overreach, which poses a risk to health and civil
liberties.4
Because the National Vaccine Information Center (NVIC) and other
organizations advocating for protection of civil liberties urged
Americans to contact the CDC and oppose the NPRM last summer, the CDC
received more than 15,000 comments from the public, many of them
expressing concern that the rule violated the U.S. Constitution, and
human and civil rights.

Although the CDC rejected this characterization, the agency did make
changes to the final rule, including eliminating a provision that would
have allowed the CDC to require individuals to agree to submit to public
health measures such as hospitalization, vaccination and medical
treatment.
In addition, the final rule states that medical examinations can only be conducted with prior informed consent.5

Who Could Be Quarantined Under the New Rule?

The new rule gives the CDC the power to detain for further health
assessment a person who is crossing the U.S. or state borders if he or
she is exhibiting certain infection symptoms associated with
quarantinable diseases, such as fever, headache and acute
gastroenteritis (abdominal cramps, loose stools or vomiting).

The new rule also makes it clear that rash and cough symptoms of
non-quarantinable infectious diseases, such as measles and pertussis,
among travelers are going to be more closely monitored by federal
government officials as well.

For non-quarantinable diseases, CDC will be working with state health
departments, who have the legal authority to detain and quarantine
citizens suspected of being infected with, or at risk for, being
infected with a communicable disease.

James Hodge Jr., a professor of public health law and ethics at the
Sandra Day O’Connor College of Law at Arizona State University, told
NPR, “Because of the breadth and scope of the definition of ill persons,
CDC can target a much wider swath of persons to assess and screen.”6

Airline Pilots and Ship Operators to Become Surveillance Crews?

The new rule also includes new reporting requirements for airplanes
and ships. If the rules take effect, airline pilots and ship operators
would be required to report not only deaths on board but also “certain
overt and common signs and symptoms of sick travelers” to the CDC prior
to arriving into the U.S. Barbara Loe Fisher, NVIC co-founder and
president noted:7

It is not a good idea to make the public’s airport
experience even more difficult by enlisting flight crews to report
passengers with symptoms that could be nothing more than eczema, acne,
norovirus or the common cold.… What started out as a vacation could be turned into a nightmare spent in an airport quarantine center.

The required signs and symptoms include the following, and must be
reported not only during international travel, but also on airline
flights flying domestically, between states:8

Airlines
(1) Fever (defined as measured temperature of 100.4 degrees F [38
degrees C] or greater, feels warm to the touch or gives a history of
feeling feverish)
AND one of the following:

Skin rash

Difficulty breathing

Persistent cough

Decreased consciousness or recent onset of confusion

New unexplained bleeding or bruising

Persistent diarrhea

Persistent vomiting (other than airsickness)

Headache with stiff neck

Appearing obviously unwell; OR

(2) Fever that has persisted for more than 48 hours; OR
(3) Other signs or symptoms of communicable disease CDC is concerned about and has announced in the Federal Register.

Ships
(1) Fever (defined as measured temperature of 100.4 degrees F [38
degrees C] or greater, feels warm to the touch or gives a history of
feeling feverish)
AND one of the following:

Skin rash

Difficulty breathing or suspected or confirmed pneumonia

Persistent cough or cough with bloody sputum

Decreased consciousness or recent onset of confusion

New unexplained bruising or bleeding

Persistent vomiting (other than seasickness)

Headache with stiff neck

Appearing obviously unwell; OR

(2) Fever that has persisted for more than 48 hours; OR
(3) Acute gastroenteritis (inflammation of stomach or intestines or both), defined as:

Diarrhea, defined as within a 24-hour period, three or more episodes
of loose stools or an occurrence of loose stools that is above normal
for the person, or

Vomiting and one or more of the following additional symptoms: one
or more episodes of loose stools in a 24-hour period, abdominal cramps,
headache, muscle aches or fever (temperature of 100.4 degrees F [38
degrees C] or greater); OR

(4) Other signs or symptoms of communicable disease CDC is concerned about and has announced in the Federal Register.

Is This Part of Global Efforts to Eradicate Measles?

In August 2016, NPRM, the CDC pointed to “the ongoing persistence of measles
in the United States” as an example of why the updated rules are
necessary. They even said, “Every case of measles in the United States
is considered a public health emergency because of its extremely high
transmissibility.”9

The World Health Organization (WHO) and U.S. health officials have
targeted mass MMR vaccination campaigns as the solution to eradicating
measles, even though serious questions remain about the vaccine’s efficacy and safety.

In the final rule, measles outbreaks in the U.S. were again
highlighted. It illustrates why travelers with a rash or cough could
become the subject of scrutiny and reporting to the CDC by airline and
other public transportation personnel as the federal government more
closely monitors almost all signs of illness in all travelers.

Will the New Rules Backfire?

Once it becomes widespread knowledge that an airline pilot or ship’s
captain must report symptoms of common illness directly to the federal
government, and that information could be used to immediately detain or
quarantine you, there’s a good chance people may try to evade the
system. Jennifer Nuzzo, a research epidemiologist at the Johns Hopkins
Center for Health Security, told NPR:10

The worst-case scenario is that people may try to
evade these procedures by, say, taking medicines to reduce their fever,
or be afraid to report it if they are feeling ill on a plane … We don’t
want to drive cases underground by putting measures in place that seem
as though they carry some penalties associated with them.

Emergency Health Measures Should Be Grounded in Science, Not Fear

While one concern is that increased surveillance of travelers by
health officials could drive diseases underground, another is that
overreaching power could allow people to be wrongly detained. An op-ed
piece in The New York Times described the case of Kaci Hickox, who had volunteered as a nurse treating Ebola patients in Sierra Leone, West Africa.

She had no known exposure to the disease, as she had worn heavy
protective gear, but upon her return to the U.S., New Jersey Gov. Chris
Christie ordered her quarantined to an area hospital. This was against
the current CDC guidelines, which stated she should monitor herself for
symptoms at home.

“It’s imperative that whenever the next outbreak hits, emergency
health measures are grounded in scientific evidence and guided by clear,
fair rules to protect people from wrongful deprivation of their
liberties,” the Times piece states, continuing:11

That incident wasn’t an anomaly. During a bubonic
plague outbreak in 1900, for example, government officials quarantined
the entire Chinatown neighborhood of San Francisco.The quarantine applied only to Chinese residents, and lacked
any scientific basis. It was fueled by little more than naked fear and
racism. Given this history, we want to ensure that federal officials
applying the new regulations will act on the basis of science and
evidence and not on politics and public fear.

What Diseases are Covered in the Quarantine Rules?

According to the new rules, “CDC may apprehend, detain, examine or
conditionally release an individual if it reasonably believes that
he/she may be infected with or exposed to a quarantinable communicable
disease.”12 Those diseases currently include the following:

Viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American and others not yet isolated or named)

Severe acute respiratory syndromes (e.g., SARS, MERS)

Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic

However, as mentioned, the new rule also allows the CDC to step up
federal surveillance of travelers displaying a number of common illness
symptoms associated with non-quarantinable diseases like measles and pertussis.

Although travelers found to be infected with or at risk for being
infected with a non-quarantinable disease like measles cannot be
quarantined by federal health officials, state health officials do have
the legal authority to detain and quarantine residents infected with
certain communicable diseases, depending upon the state’s public health
laws.

The final rule was originally scheduled to go into effect Feb. 21,
2017. However, with the change in administration, the new regulations
are being reviewed and will not take effect until the end of March 2017,
at the earliest.13